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Find video protocols related to scientific articles indexed in Pubmed.
Contemporary outcomes with percutaneous vascular interventions for peripheral critical limb ischemia in those with and without poly-vascular disease.
Vasc Med
PUBLISHED: 10-09-2014
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Given the very ill nature of patients with critical limb ischemia (CLI), the use of percutaneous vascular interventions (PVIs) for limb salvage may or may not be efficacious; in particular, for those with polyvascular arterial disease. Herein, we reviewed large, multi-institutional outcomes of PVI in polyvascular and peripheral arterial disease (PAD) patients with CLI. An 18-hospital consortium collected prospective data on patients undergoing endovascular interventions for PAD with 6-month follow-up from January 2008 to December 2011. The patient cohort included 4459 patients with CLI; of those, 3141 patients had polyvascular (coronary artery disease, cerebrovascular disease and PAD) disease, whereas 1318 patients suffered from only PAD. All patients were elderly and with significant comorbidities. The mean ankle-brachial index (ABI) was 0.44 and was not different between those with and without polyvascular disease. Polyvascular patients had more femoropopliteal and infra-inguinal interventions and less aortoiliac interventions than PAD patients. Pre- and post-procedural cardioprotective medication use was less in the PAD patients as compared with polyvascular patients. Vascular complications requiring surgery were higher in PAD patients whereas other access complications were similar between groups. At 6-month follow-up, death was more common in the polyvascular group (6.7% vs 4.1%, p<0.001) as was repeat PVI, but no difference was found in the amputation rate. Considering the group as a whole at the 6-month follow-up, predictors of amputation/death included age (HR=1.01; 95% CI=1.002-1.02), anemia (HR=2.6; 95% CI=2.1-3.2), diabetes mellitus (HR=1.6; 95% CI=1.3-1.9), congestive heart failure (HR=1.6; 95% CI=1.4-1.9), and end-stage renal failure (HR=1.9; 95% CI=1.5-2.3), while female sex was protective (HR=0.7; 95% CI=0.6-0.8). In conclusion, from examination of this large, multicenter, multi-specialist practice registry, patients with polyvascular disease had higher 6-month mortality than PAD patients, but this was not a factor in 6-month limb amputation outcomes. This study also underscores that PAD patients still lag in cardioprotective medication use as compared with polyvascular patients.
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Renal denervation using focused infrared fiber lasers: A potential treatment for hypertension.
Lasers Surg Med
PUBLISHED: 08-29-2014
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Renal denervation has recently become of great interest as a potential treatment for resistant hypertension. Denervation techniques using radio frequency (RF) or ultrasound energy sources have already been explored in literature. In this study, we investigate the use of lasers as a potential energy source for renal denervation. In vitro studies are performed in porcine/ovine renal arteries with focused laser beams at 980?nm, 1210?nm, and 1700?nm to study the ability to damage renal nerves without causing injury to non-target tissue structures like the endothelium. Then, a 980?nm laser catheter prototype is built and used to demonstrate in vivo renal denervation in ovine renal arteries.
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In-hospital switching between clopidogrel and prasugrel among patients with acute myocardial infarction treated with percutaneous coronary intervention: insights into contemporary practice from the national cardiovascular data registry.
Circ Cardiovasc Interv
PUBLISHED: 08-05-2014
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Although randomized clinical trials have compared clopidogrel with higher potency ADP receptor inhibitors (ADPris) among patients with myocardial infarction, little is known about the frequency and factors associated with switching between ADPris in clinical practice.
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Differences in sex-related bleeding and outcomes after percutaneous coronary intervention: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry.
Am. Heart J.
PUBLISHED: 07-17-2014
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Bleeding after percutaneous coronary intervention (PCI) is more common in women than in men. However, the relationship of sex and bleeding with outcomes is less well studied.
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Change in hospital-level use of transradial percutaneous coronary intervention and periprocedural outcomes: insights from the national cardiovascular data registry.
Circ Cardiovasc Qual Outcomes
PUBLISHED: 06-04-2014
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Whether increasing use of radial access has improved percutaneous coronary intervention outcomes remains unknown. We sought to determine the relationship between increasing facility-level use of transradial percutaneous coronary intervention (TRI) and periprocedural outcomes.
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The epidemiology and outcomes of percutaneous coronary intervention before high-risk noncardiac surgery in contemporary practice: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry.
J Am Heart Assoc
PUBLISHED: 05-14-2014
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Percutaneous coronary intervention (PCI) is sometimes performed with the intent to lower cardiovascular risk before high-risk noncardiac surgery (HRNCS). There are limited data on the frequency and outcome of PCIs performed in this setting.
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Risk of acute kidney injury after percutaneous coronary interventions using radial versus femoral vascular access: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
Circ Cardiovasc Interv
PUBLISHED: 02-25-2014
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Transradial percutaneous coronary intervention (PCI [TRI]) does not involve catheter manipulation in the descending aorta, whereas transfemoral PCI (TFI) does. Therefore, the risk of acute kidney injury (AKI) after PCI might be influenced by vascular access site. We compared risks of AKI and nephropathy requiring dialysis (NRD) among patients treated with TRI and TFI.
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Preprocedural statin use in patients undergoing percutaneous coronary intervention.
Am. Heart J.
PUBLISHED: 01-14-2014
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Earlier studies suggest that administering statins prior to percutaneous coronary interventions (PCIs) is associated with lower risk of periprocedural myocardial infarction and contrast-induced nephropathy. Current American College of Cardiology/American Heart Association guidelines recommend routine use of statins prior to PCI. It is unclear how commonly this recommendation is followed in clinical practice and what its effect on outcomes is.
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Daylight savings time and myocardial infarction.
Open Heart
PUBLISHED: 01-01-2014
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Prior research has shown a transient increase in the incidence of acute myocardial infarction (AMI) after daylight savings time (DST) in the spring as well as a decrease in AMI after returning to standard time in the fall. These findings have not been verified in a broader population and if extant, may have significant public health and policy implications.
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A random forest based risk model for reliable and accurate prediction of receipt of transfusion in patients undergoing percutaneous coronary intervention.
PLoS ONE
PUBLISHED: 01-01-2014
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Transfusion is a common complication of Percutaneous Coronary Intervention (PCI) and is associated with adverse short and long term outcomes. There is no risk model for identifying patients most likely to receive transfusion after PCI. The objective of our study was to develop and validate a tool for predicting receipt of blood transfusion in patients undergoing contemporary PCI.
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The association between contrast dose and renal complications post PCI across the continuum of procedural estimated risk.
PLoS ONE
PUBLISHED: 01-01-2014
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Prior studies have proposed to restrict the contrast volume (CV) to <3x calculated creatinine clearance (CCC), to prevent contrast induced nephropathy (CIN) post percutaneous coronary interventions (PCI). The predictive value of this algorithm for CIN and therefore the benefit of this approach in high risk patients has been questioned. The aim of our study was to assess the association between contrast dose and the occurrence of CIN in patients at varying predicted risks of CIN and baseline CCC following contemporary PCI.
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False activation of the cardiac catheterization laboratory for primary PCI.
Am J Manag Care
PUBLISHED: 12-06-2013
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We sought to evaluate trends in door-to-balloon (D2B) times and false activation rates for the cardiac catheterization laboratory (CCL) in patients presenting to the emergency department (ED) with acute ST-elevation myocardial infarction (STEMI). In patients with STEMI, national efforts have focused on reducing D2B times for primary percutaneous coronary intervention (P-PCI). This emphasis on time-to-treatment may increase the rate of false CCL activations and unnecessary healthcare utilization.
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Impact of Worsening Renal Dysfunction on the Comparative Efficacy of Bivalirudin and Platelet Glycoprotein IIb/IIIa Inhibitors: Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
Circ Cardiovasc Interv
PUBLISHED: 11-26-2013
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Use of bivalirudin has been associated with a reduction in the incidence of bleeding in patients undergoing percutaneous coronary intervention. Patients with chronic kidney disease, a known predictor of post-percutaneous coronary intervention bleeding, are under-represented in clinical trials.
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Comparative safety of vascular closure devices and manual closure among patients having percutaneous coronary intervention.
Ann. Intern. Med.
PUBLISHED: 11-20-2013
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The role of vascular closure devices (VCDs) in patients having percutaneous coronary intervention (PCI) is controversial, and recommendations for use vary.
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Door-to-balloon time and mortality among patients undergoing primary PCI.
N. Engl. J. Med.
PUBLISHED: 09-06-2013
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Current guidelines for the treatment of ST-segment elevation myocardial infarction recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention (PCI). Door-to-balloon time has become a performance measure and is the focus of regional and national quality-improvement initiatives. However, it is not known whether national improvements in door-to-balloon times have been accompanied by a decline in mortality.
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Patient and hospital characteristics associated with inappropriate percutaneous coronary interventions.
J. Am. Coll. Cardiol.
PUBLISHED: 07-08-2013
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This study sought to examine whether rates of inappropriate percutaneous coronary intervention (PCI) differ by demographic characteristics and insurance status.
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The clinical outcomes of percutaneous coronary intervention performed without pre-procedural aspirin.
J. Am. Coll. Cardiol.
PUBLISHED: 06-27-2013
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The purpose of this study was to examine the incidence and outcomes of percutaneous coronary intervention (PCI) performed in patients who had not received pre-procedural aspirin.
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The burgeoning epidemic of morbid obesity in patients undergoing percutaneous coronary intervention: insight from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
J. Am. Coll. Cardiol.
PUBLISHED: 05-31-2013
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This study sought to examine the prevalence and clinical implications of morbid obesity among patients undergoing percutaneous coronary intervention (PCI).
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Contemporary use of prasugrel in clinical practice: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
Circ Cardiovasc Qual Outcomes
PUBLISHED: 05-14-2013
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Prasugrel is a recently approved thienopyridine for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. There are no data on contemporary use of prasugrel in routine clinical practice.
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Outcome of percutaneous coronary intervention following recent surgery.
Am. J. Cardiol.
PUBLISHED: 05-12-2013
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Outcome data regarding postoperative acute coronary syndrome treated with percutaneous coronary intervention (PCI) are limited. The objective of this study was to determine clinical outcomes of patients undergoing PCI within 7 days after a surgical procedure. We assessed outcomes of 517 patients who underwent PCI within 7 days after a surgery across 44 hospitals from January 2010 to December 2011 from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry. Patients with postoperative PCI were compared with all other patients with PCI using propensity-matched analysis. Of the 65,175 patients who underwent PCI within the study period, 517 patients had undergone surgery within the previous 7 days. In unadjusted analysis, patients with postsurgical PCI had higher in-hospital mortality (6.96% vs 1.33%), stroke (0.96% vs 0.26%), bleeding events (6.96% vs 2.6%), heart failure (6.96% vs 2.36%), and cardiogenic shock (7.16% vs 1.95%). After propensity matching, mortality remained higher in postsurgical patients (6.5% vs 3.96%, odds ratio 1.7 [1.1 to 2.6], p = 0.02). The odds of mortality were especially high among patients who would otherwise be considered low risk (<1% of predicted mortality in a nonsurgical setting) in whom a recent surgery was strongly associated with death (odds ratio 5.7, p = 0.02). In conclusion, PCI performed within 7 days after a surgical procedure is associated with an increased risk of early mortality. Although some of this increased risk is related to an adverse clinical profile, higher mortality is also observed in patients otherwise considered low risk for PCI.
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Predicting complications of percutaneous coronary intervention using a novel support vector method.
J Am Med Inform Assoc
PUBLISHED: 04-18-2013
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To explore the feasibility of a novel approach using an augmented one-class learning algorithm to model in-laboratory complications of percutaneous coronary intervention (PCI).
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A pulsatile blood vessel system for a femoral arterial access clinical simulation model.
Med Eng Phys
PUBLISHED: 04-05-2013
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The model-based, rapid-prototyping-enabled design and manufacture of a pulsatile blood vessel (PBV) for high-fidelity mannequin-based clinical simulations is presented. The PBV presented here is a pressurized, flexible tube with alternating fluid pressure created by a pump to mimic the behavior of a human vessel in response to pulsatile pressure. The use of PBVs is important for the fidelity of a clinical simulator that requires residents to palpate and/or access the vessel. In this study, a PBV is presented which features the integration of 3D modeling using patient-specific computed tomography (CT) data, mold fabrication using rapid-prototyping, and finite element method for estimating the required pumping pressure to generate the same level of force (about 1.5 N) experienced by the user through palpation. The relationship between this palpation force and the vessel pressure is studied using two strategies: finite element analysis (FEA) and experiments in a femoral arterial access simulator with a pump, artificial vessel, and surrounding phantom tissue. The experimental results show a discrepancy of 8.7% from the FEA-predicted value. Qualitative validation is done by exposing and surveying 19 interventional cardiology residents at four major educational institutions to the simulator for accuracy of its feel. The overall survey results are positive.
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Impact of automated contrast injector systems on contrast use and contrast-associated complications in patients undergoing percutaneous coronary interventions.
JACC Cardiovasc Interv
PUBLISHED: 03-20-2013
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The purpose of this study was to assess the impact of manual versus automated contrast injection on renal complications in patients undergoing percutaneous coronary intervention (PCI).
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Impact of pre-procedural beta blockade on inpatient mortality in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction.
Am. J. Cardiol.
PUBLISHED: 02-17-2013
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Early use of ? blockers (BBs) in acute myocardial infarction remains controversial, with some studies demonstrating benefit and others harm. The aim of this study was to assess the association between pre-percutaneous coronary intervention (PCI) BB use and in-hospital outcomes in patients who underwent primary PCI for ST-segment elevation myocardial infarction between 2007 and 2009 at institutions participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC-2). Inverse propensity score weighting was used to account for the nonrandomized use of pre-PCI BBs. The cohort comprised 7,667 patients, with 4,769 (62%) receiving pre-PCI BBs. These patients were older, with higher rates of diabetes mellitus, hypertension, and previous myocardial infarction, PCI, or coronary artery bypass grafting. In adjusted models, pre-PCI BB use was associated with lower rates of intraprocedural ventricular tachycardia or ventricular fibrillation (odds ratio [OR] 0.58, p <0.01) and lower in-hospital mortality (OR 0.65, p = 0.022), with increases in rates of emergent coronary artery bypass grafting (OR 1.56, p <0.01) and repeat PCI (OR 1.93, p <0.01). There were no significant increases in rates of cardiogenic shock and congestive heart failure. In conclusion, pre-PCI BB use in this population was associated with decreased arrhythmia and mortality, without increasing rates of cardiogenic shock and heart failure but with higher rates of repeat PCI and emergent coronary artery bypass grafting, suggesting that there may yet remain a role for early BB use in pre-PCI patients with ST-segment elevation myocardial infarctions.
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The association between patient race, treatment, and outcomes of patients undergoing contemporary percutaneous coronary intervention: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).
Am. Heart J.
PUBLISHED: 02-16-2013
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The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI).
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Non-invasive embolus trap using histotripsy-an acoustic parameter study.
Ultrasound Med Biol
PUBLISHED: 02-13-2013
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Free-flowing particles in a blood vessel were observed to be attracted, trapped and eroded by a histotripsy bubble cloud. This phenomenon may be used to develop a non-invasive embolus trap (NET) to prevent embolization. This study investigates the effect of acoustic parameters on the trapping ability of the NET generated by a focused 1.063 MHz transducer. The maximum trapping velocity, defined by the maximum mean fluid velocity at which a 3-4 mm particle trapped in a 6 mm diameter vessel phantom, increased linearly with peak negative pressure (P-) and increased as the square root of pulse length and pulse repetition frequency (PRF). At 19.9 MPa P-, 1000 Hz PRF and 10 cycle pulse length, a 3 mm clot-mimicking particle could remain trapped under a background velocity of 9.7 cm/s. Clot fragments treated by NET resulted in debris particles <75 ?m. These results will guide the appropriate selection of NET parameters.
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Differences in the outcome of patients undergoing percutaneous coronary interventions at teaching versus non-teaching hospitals.
Am. Heart J.
PUBLISHED: 01-28-2013
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Teaching hospitals have superior outcomes for major medical conditions including cardiovascular disease compared to non-teaching hospitals. This may not be applicable to invasive cardiac procedures given a potential increase in complications due to trainee participation.
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Current medical management of stable coronary artery disease before and after elective percutaneous coronary intervention.
Am. Heart J.
PUBLISHED: 01-17-2013
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Percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) is not superior to optimal medical therapy. It remains unclear if patients who receive PCI for stable CAD are receiving appropriate medical therapy.
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A novel tool for reliable and accurate prediction of renal complications in patients undergoing percutaneous coronary intervention.
J. Am. Coll. Cardiol.
PUBLISHED: 01-15-2013
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The aim of the study was to develop and validate a tool for predicting risk of contrast-induced nephropathy (CIN) in patients undergoing contemporary percutaneous coronary intervention (PCI).
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Operator experience and carotid stenting outcomes in Medicare beneficiaries.
JAMA
PUBLISHED: 09-29-2011
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Although the efficacy of carotid stenting has been established in clinical trials, outcomes of the procedure based on operator experience are less certain in clinical practice.
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Physician specialty and carotid stenting among elderly medicare beneficiaries in the United States.
Arch. Intern. Med.
PUBLISHED: 08-08-2011
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The use of carotid stenting is rising across the United States. How physician specialty relates to its utilization rates or outcomes is uncertain.
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How a regional collaborative of hospitals and physicians in Michigan cut costs and improved the quality of care.
Health Aff (Millwood)
PUBLISHED: 04-08-2011
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There is evidence that collaborations between hospitals and physicians in particular regions of the country have led to improvements in the quality of care. Even so, there have not been many of these collaborations. We review one, the Michigan regional collaborative improvement program, which was paid for by a large private insurer, has yielded improvements for a range of clinical conditions, and has reduced costs in several important areas. In general and vascular surgery alone, complications from surgery dropped almost 2.6 percent among participating Michigan hospitals-a change that translates into 2,500 fewer Michigan patients with surgical complications each year. Estimated annual savings from this one collaborative are approximately $20 million, far exceeding the cost of administering the program. Regional collaborative improvement programs should become increasingly attractive to hospitals and physicians, as well as to national policy makers, as they seek to improve health care quality and reduce costs.
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Comparison of acute coronary syndrome in patients receiving versus not receiving chronic dialysis (from the Global Registry of Acute Coronary Events [GRACE] Registry).
Am. J. Cardiol.
PUBLISHED: 04-06-2011
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Patients with end-stage renal disease commonly develop acute coronary syndromes (ACS). Little is known about the natural history of ACS in patients receiving dialysis. We evaluated the presentation, management, and outcomes of patients with ACS who were receiving dialysis before presentation for an ACS and were enrolled in the Global Registry of Acute Coronary Events (GRACE) at 123 hospitals in 14 countries from 1999 to 2007. Of 55,189 patients, 579 were required dialysis at presentation. Non-ST-segment elevation myocardial infarction was the most common ACS presentation in patients receiving dialysis, occurring in 50% (290 of 579) of patients versus 33% (17,955 of 54,610) of those not receiving dialysis. Patients receiving dialysis had greater in-hospital mortality rates (12% vs 4.8%; p <0.0001) and, among those who survived to discharge, greater 6-month mortality rates (13% vs 4.2%; p <0.0001), recurrent myocardial infarction (7.6% vs 2.9%; p <0.0001), and unplanned rehospitalization (31% vs 18%; p <0.0001). The outcome in patients receiving dialysis was worse than that predicted by their calculated GRACE risk score for in-hospital mortality (7.8% predicted vs 12% observed; p <0.05), 6-month mortality/myocardial infarction (10% predicted vs 21% observed; p <0.05). In conclusion, in the present large multinational study, approximately 1% of patients with ACS were receiving dialysis. They were more likely to present with non-ST-segment elevation myocardial infarction, and had markedly greater in-hospital and 6-month mortality. The GRACE risk score underestimated the risk of major events in patients receiving dialysis.
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Outcome of contemporary percutaneous coronary intervention in the elderly and the very elderly: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
Clin Cardiol
PUBLISHED: 03-22-2011
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There is a paucity of data on the outcome of contemporary percutaneous coronary intervention (PCI) in the elderly. Accordingly, we assessed the impact of age on outcome of a large cohort of patients undergoing PCI in a regional collaborative registry.
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Trends and disparities in referral to cardiac rehabilitation after percutaneous coronary intervention.
Am. Heart J.
PUBLISHED: 03-12-2011
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Despite the known benefits of cardiac rehabilitation in patients with coronary artery disease, referral rates to rehabilitation programs remain low. We determined the incidence and determinants of cardiac rehabilitation referral rates for patients undergoing percutaneous coronary intervention (PCI).
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The association of sex with outcomes among patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction in the contemporary era: Insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2)
Am. Heart J.
PUBLISHED: 02-24-2011
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historically, women with ST elevation myocardial infarction (STEMI) have had a higher mortality compared with men. It is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI) with focus on early reperfusion.
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Safety of contemporary percutaneous peripheral arterial interventions in the elderly insights from the BMC2 PVI (Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention) registry.
JACC Cardiovasc Interv
PUBLISHED: 02-23-2011
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This study sought to evaluate the effect of age on procedure type, periprocedural management, and in-hospital outcomes of patients undergoing lower-extremity (LE) peripheral vascular intervention (PVI).
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Renal function-based contrast dosing to define safe limits of radiographic contrast media in patients undergoing percutaneous coronary interventions.
J. Am. Coll. Cardiol.
PUBLISHED: 02-16-2011
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The aim of this study was to evaluate the association between calculated creatinine clearance (CCC)-based contrast dose and renal complications in patients undergoing percutaneous coronary interventions (PCI).
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Treatment and outcomes of first troponin-negative non-ST-segment elevation myocardial infarction.
Am. J. Cardiol.
PUBLISHED: 02-09-2011
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Little is known about non-ST-segment elevation myocardial infarction (MI) in patients with an initial negative troponin finding. The aim of this study was to determine in post hoc analysis of a large regional medical center presenting clinical characteristics, treatment differences, and in-hospital and 6-month outcomes of first troponin-negative MI (FTNMI). In this study, 659 of 1,855 consecutive patients with non-ST-segment elevation MI (35.5%) were classified as having FTNMI. In-hospital cardiac catheterization rates were similar between the 2 groups (70.1% vs 71.5%, p = 0.53) In hospital, patients with FTNMI were less likely to receive statins (48.9% vs 59.9%, p <0.001). On discharge, patients with FTNMI were less likely to be on clopidogrel (53.1% vs 59.0%, p = 0.019) and statins (67.7% vs 75.2%, p <0.001). At 6-month follow-up, patients with FTNMI were less likely to be on clopidogrel (43.5% vs 55.2%, p = 0.01) In-hospital recurrent ischemia was 2 times as common in FTNMI (20.1% vs 11.5%, p <0.001). There were no differences, however, in congestive heart failure, cardiogenic shock, cardiac arrest, stroke, or death in hospital. At 6 months, patients with FTNMI were 2 times as likely to have had recurrent MI (12.0% vs 6.6%, p <0.001). Combined end points of death at 6 months, MI, stroke, and rehospitalization were higher for FTNMI (47.7% vs 40.9%, p = 0.017); however, this was due to higher rates of recurrent MI. In conclusion, patients with FTNMI received less aggressive pharmacotherapy and were 2 times as likely to have recurrent MI at 6 months. FTNMI is common and represents a clinical entity that should be treated more aggressively.
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Defining the optimal dose of aspirin and clopidogrel in acute coronary syndromes. Evaluation of ‘Dose comparisons of clopidogrel and aspirin in acute coronary syndromes’, N Engl J Med 2010;363:930-42.
Expert Opin Pharmacother
PUBLISHED: 11-26-2010
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Platelet inhibition is integral to the contemporary management of acute coronary syndromes. While aspirin and clopidogrel are used almost universally in patients treated with an early invasive strategy, the optimal dosing strategy for these drugs remains unknown. In a large randomized trial, the OASIS-CURRENT 7, investigators demonstrated no benefit of a higher dose of aspirin. There was no overall benefit of a higher dose of clopidogrel, although in patients treated with percutaneous coronary intervention a double-dose strategy was associated with a reduction in stent thrombosis and other ischemic events at the cost of an increased risk of bleeding events.
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Trends in door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Arch. Intern. Med.
PUBLISHED: 11-10-2010
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In patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing percutaneous coronary intervention, current guidelines for reperfusion therapy recommend a door-to-balloon (DTB) time of less than 90 minutes. Considerable effort has focused on reducing DTB time with the assumption that a reduction in DTB time translates into a significant reduction in mortality; however, the clinical impact of this effort has not been evaluated. Therefore, our objective was to determine whether a decline in DTB time in patients with STEMI was associated with an improvement in clinical outcomes.
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Defining the optimal degree of heparin anticoagulation for peripheral vascular interventions: insight from a large, regional, multicenter registry.
Circ Cardiovasc Interv
PUBLISHED: 11-09-2010
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The optimal degree of heparin anticoagulation for peripheral vascular interventions (PVIs) has not been defined. We sought to correlate total heparin dose and peak procedural activated clotting time (ACT) with postprocedural outcomes in patients undergoing PVI.
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Fragmented QRS complex has poor sensitivity in detecting myocardial scar.
Ann Noninvasive Electrocardiol
PUBLISHED: 10-16-2010
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To study the association of the fragmented QRS complex versus the Q wave with myocardial scar and viability.
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The relative renal safety of iodixanol and low-osmolar contrast media in patients undergoing percutaneous coronary intervention. Insights from Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).
J Invasive Cardiol
PUBLISHED: 10-15-2010
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Contrast-induced acute kidney injury (CI-AKI) is a common complication of percutaneous coronary intervention (PCI). Current guidelines support the use of iodixanol (Visipaque®, GE Healthcare, Princeton, New Jersey) in patients at high risk for CI-AKI. Recent trials and meta-analyses have shown no difference in CI-AKI when iodixanol is compared to low-osmolar contrast media (LOCM). We evaluated the incidence of CI-AKI, in-hospital dialysis and in-hospital death in 58,957 patients who underwent PCI in 2007 and 2008 in a large regional consortium of 31 hospitals and who were treated with iodixanol (n = 17,814) or LOCM (n = 41,143). Propensity-matched analysis was performed to adjust for differences in baseline variables. Patients treated with iodixanol compared to those treated with LOCM were slightly older, had more medical comorbidities and a higher baseline creatinine (1.35 ± 1.07 mg/dL versus 1.10 ± 0.85 mg/dL; p < 0.0001). In propensity-matched, risk-adjusted models, there was no significant difference between iodixanol and LOCM in the risk of CIAKI (4.54% vs. 4.14%; p = 0.14), need for dialysis (0.37% vs. 0.43%; p = 0.35) or death (1.46% vs. 1.39%; p = 0.18). Among patients undergoing PCI, the use of iodixanol was more frequent in older patients with more comorbidities and worse baseline renal function. There was no difference in the adjusted risk of CI-AKI among patients treated with iodixanol compared with those treated with LOCM.
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M-118, a novel, low-molecular-weight heparin for the potential treatment of cardiovascular disorders.
Curr Opin Investig Drugs
PUBLISHED: 08-24-2010
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Safe inhibition of thrombosis is a key therapeutic strategy in modern cardiovascular medicine, and both unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are commonly used in clinical practice. However, both have several drawbacks, such as the unpredictable pharmacokinetics of UFH and the non-reversibility of LMWH. M-118, being developed by Momenta Pharmaceuticals Inc, is a novel LMWH that has been engineered to overcome the drawbacks of UFH and currently available LMWHs, while maintaining their beneficial attributes. In preclinical studies and phase I clinical trials, M-118 demonstrated potent activity against thrombin and Factor Xa, which could be reversed with protamine; M-118 also demonstrated a high and predictable bioavailability, and a short half-life. Promising results were observed in a phase II clinical trial in patients undergoing coronary interventions, although phase III clinical trials are required to establish the role for M-118 in contemporary medicine.
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Case report: the effect of proton pump inhibitor administration on hemodynamics in a cardiac intensive care unit.
Clin Cardiol
PUBLISHED: 06-17-2010
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Ex vivo studies have suggested that high dose proton pump inhibitors (PPI) may have negative inotropic effects in myocardial tissue. We sought to investigate this concept in a real-world clinical setting. In this case series, we enrolled critically ill patients in the coronary and cardiothoracic intensive care units who had a preexisting pulmonary artery (PA) catheter in place for hemodynamic monitoring and were on a PPI for prespecified clinical indications. Hemodynamic measurements were made at baseline and then at 15 minute intervals for 1 hour after PPI administration. A total of 18 patients were evaluated; 72% were male with a mean age of 59.9 years. A total of 9 patients were evaluated on 2 consecutive days, yielding 26 patient-exposures to the medication. The majority of patients (72%) were receiving 1 or more inotropic agents (n = 6), a vasopressor (n = 4), or both (n = 4). When compared to baseline values, there was no significant change in mean arterial pressure (baseline 80 +/- 11 mm Hg), heart rate (87 +/- 11 bpm), or Fick cardiac index (2.7 +/- 1.8 L/min/m(2)). Mean PA pressure did decrease transiently at 45 minutes following PPI administration (28.5 +/- 7.7 mm Hg at baseline vs 26.5 +/- 7.5 mm Hg, P = 0.017), but is unlikely to be of clinical significance. In conclusion, these data suggest that IV PPIs do not immediately impact important hemodynamic parameters and are likely safe in a high-risk intensive care setting.
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Retroperitoneal hematoma after percutaneous coronary intervention: prevalence, risk factors, management, outcomes, and predictors of mortality: a report from the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry.
JACC Cardiovasc Interv
PUBLISHED: 04-29-2010
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This study sought to evaluate the prevalence, risk factors, outcomes, and predictors of mortality of retroperitoneal hematoma (RPH) following percutaneous coronary intervention.
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Gender differences in adverse outcomes after contemporary percutaneous coronary intervention: an analysis from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) percutaneous coronary intervention registry.
Am. Heart J.
PUBLISHED: 04-06-2010
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Prior studies have shown a relationship between female gender and adverse outcomes after percutaneous coronary interventions (PCIs). Whether this relationship still exists with contemporary PCI remains to be determined.
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Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.
PLoS ONE
PUBLISHED: 03-30-2010
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Saphenous vein grafts develop an aggressive atherosclerotic process and the efficacy of drug eluting stents (DES) in treating saphenous vein graft (SVG) lesions has not been convincingly demonstrated. The aim of this study was to review and analyze the current literature for controlled studies comparing DES versus bare metal stents (BMS) for treatment of SVG stenoses.
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Temporal trends in the use of drug-eluting stents for approved and off-label indications: a longitudinal analysis of a large multicenter percutaneous coronary intervention registry.
Clin Cardiol
PUBLISHED: 02-27-2010
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We sought to examine the temporal variations in the rate of both bare-metal stent (BMS) and drug-eluting stent (DES) use for off-label indications after the reports of an increased risk of very late stent thrombosis in patients with DES at the 2006 meeting of the European Society of Cardiology (ESC).
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Safety and efficacy of thrombectomy in patients undergoing primary percutaneous coronary intervention for acute ST elevation MI: a meta-analysis of randomized controlled trials.
BMC Cardiovasc Disord
PUBLISHED: 02-26-2010
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Clinical trials comparing thrombectomy devices with conventional percutaneous coronary interventions (PCI) in patients with acute ST elevation myocardial infarction (STEMI) have produced conflicting results. The objective of our study was to systematically evaluate currently available data comparing thrombectomy followed by PCI with conventional PCI alone in patients with acute STEMI.
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Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials.
BMJ
PUBLISHED: 02-16-2010
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To evaluate the relative short term safety and intermediate term efficacy of carotid endarterectomy versus carotid artery stenting.
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Noninvasive treatment of deep venous thrombosis using pulsed ultrasound cavitation therapy (histotripsy) in a porcine model.
J Vasc Interv Radiol
PUBLISHED: 01-26-2010
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This study evaluated histotripsy as a noninvasive, image-guided method of thrombolysis in a porcine model of deep vein thrombosis. Histotripsy therapy uses short, high-intensity, focused ultrasound pulses to cause mechanical breakdown of targeted soft tissue by acoustic cavitation, which is guided by real-time ultrasound imaging. This is an in vivo feasibility study of histotripsy thrombolysis.
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Efficacy of cilostazol in reducing restenosis in patients undergoing contemporary stent based PCI: a meta-analysis of randomised controlled trials.
EuroIntervention
PUBLISHED: 09-09-2009
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Aims: Cilostazol has been associated with reduction in restenosis in patients undergoing coronary and peripheral arterial angioplasty. Our objective was to evaluate the impact of cilostazol on restenosis in patients undergoing contemporary PCI with bare metal (BMS) or drug eluting stents (DES) and treated with aspirin and thienopyridine.Methods and results: Ten randomised trials (n=2,809 patients) comparing triple antiplatelet therapy (aspirin, thienopyridine and cilostazol) with standard dual antiplatelet therapy were included. Summary risk ratios for restenosis, late loss, target lesion revascularisation (TLR) and target vessel revascularisation (TVR) were calculated using fixed-effects models. Cilostazol was associated with a significant reduction in late loss in BMS (mean difference 0.24 mm, 95% CI 0.15-0.33, p<0.001) and DES groups (mean difference 0.12 mm, 95% CI 0.07-0.18, p<0.001). Cilostazol therapy was associated with a significant reduction in angiographic restenosis (Odds ratio [OR] 0.52, 95% CI 0.41- 0.66, p<0.001) with consistent benefits in patients treated with BMS (OR 0.49, 95% CI 0.35-0.70, p<0.001) or DES (OR 0.54, 95% CI 0.38-0.76, p=0.001). Addition of cilostazol to dual antiplatelet therapy was associated with a significant reduction in TLR (OR 0.38, 95% CI 0.25-0.58, p<0.001), with no difference in subacute stent thrombosis (OR 1.91, 95% CI 0.33-11.08, p=0.47), or major bleeding (OR 0.87, 95% CI 0.44-1.74, P=0.69) but with an increased risk of skin rash (OR 3.67, 95% CI 1.86-7.24, p<0.001).Conclusions: Cilostazol in addition to dual antiplatelet therapy is associated with a reduction in angiographic restenosis in patients undergoing stent based PCI. This inexpensive drug may be particularly beneficial in patients who are at high risk of restenosis and it should undergo further evaluation in large, definitive randomised controlled trials.
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Does simplicity compromise accuracy in ACS risk prediction? A retrospective analysis of the TIMI and GRACE risk scores.
PLoS ONE
PUBLISHED: 09-08-2009
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The Thrombolysis in Myocardial Infarction (TIMI) risk scores for Unstable Angina/Non-ST-elevation myocardial infarction (UA/NSTEMI) and ST-elevation myocardial infarction (STEMI) and the Global Registry of Acute Coronary Events (GRACE) risk scores for in-hospital and 6-month mortality are established tools for assessing risk in Acute Coronary Syndrome (ACS) patients. The objective of our study was to compare the discriminative abilities of the TIMI and GRACE risk scores in a broad-spectrum, unselected ACS population and to assess the relative contributions of model simplicity and model composition to any observed differences between the two scoring systems.
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Risk Factors in first presentation acute coronary syndromes (ACS): how do we move from population to individualized risk prediction?
Angiology
PUBLISHED: 09-02-2009
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Patients with acute coronary syndromes (ACS) have a poor short- and long-term prognosis. We sought to examine the presence of established coronary risk factors in contemporary patients presenting with an ACS for the first time and no known coronary artery disease (CAD) in the past. The study was conducted in 3171 consecutive patients admitted with the diagnosis of ACS. Of these, 941 patients (30%) had the admission as the first occurrence of ACS and no prior history of CAD. We studied the degree to which these first presenters with ACS had 1 or more established risk factors. We found that 98% of patients presenting with an ACS for the first time and no previous CAD had at least 1 established risk factor. Current population-based screening efforts must be improved to allow more effective prevention strategies and more individualized risk prediction.
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Impact of blood transfusion on short- and long-term mortality in patients with ST-segment elevation myocardial infarction.
JACC Cardiovasc Interv
PUBLISHED: 05-26-2009
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We sought to examine the short- and long-term outcomes of blood transfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI).
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Noninvasive thrombolysis using pulsed ultrasound cavitation therapy - histotripsy.
Ultrasound Med Biol
PUBLISHED: 05-24-2009
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Clinically available thrombolysis techniques are limited by either slow reperfusion (drugs) or invasiveness (catheters) and carry significant risks of bleeding. In this study, the feasibility of using histotripsy as an efficient and noninvasive thrombolysis technique was investigated. Histotripsy fractionates soft tissue through controlled cavitation using focused, short, high-intensity ultrasound pulses. In vitro blood clots formed from fresh canine blood were treated by histotripsy. The treatment was applied using a focused 1-MHz transducer, with five-cycle pulses at a pulse repetition rate of 1kHz. Acoustic pressures varying from 2 to 12MPa peak negative pressure were tested. Our results show that histotripsy can perform effective thrombolysis with ultrasound energy alone. Histotripsy thrombolysis only occurred at peak negative pressure >or=6MPa when initiation of a cavitating bubble cloud was detected using acoustic backscatter monitoring. Blood clots weighing 330mg were completely broken down by histotripsy in 1.5 to 5min. The clot was fractionated to debris with >96% weight smaller than 5mum diameter. Histotripsy thrombolysis treatment remained effective under a fast, pulsating flow (a circulatory model) as well as in static saline. Additionally, we observed that fluid flow generated by a cavitation cloud can attract, trap and further break down clot fragments. This phenomenon may provide a noninvasive method to filter and eliminate hazardous emboli during thrombolysis.
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Percutaneous coronary intervention complications and guide catheter size: bigger is not better.
JACC Cardiovasc Interv
PUBLISHED: 05-21-2009
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We evaluated the association between guiding catheter size and complications of percutaneous coronary intervention (PCI).
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The relative renal safety of iodixanol compared with low-osmolar contrast media: a meta-analysis of randomized controlled trials.
JACC Cardiovasc Interv
PUBLISHED: 04-24-2009
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We sought to compare the nephrotoxicity of the iso-osmolar contrast medium, iodixanol, to low-osmolar contrast media (LOCM).
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A comparison of abciximab and small-molecule glycoprotein IIb/IIIa inhibitors in patients undergoing primary percutaneous coronary intervention: a meta-analysis of contemporary randomized controlled trials.
Circ Cardiovasc Interv
PUBLISHED: 04-21-2009
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Current guidelines recommend abciximab as the preferred agent for patients undergoing primary percutaneous coronary intervention, yet small-molecule glycoprotein IIb/IIIa inhibitors are more commonly used in clinical practice. The objective of our meta-analysis was to evaluate for differences in clinical outcome between small-molecule glycoprotein IIb/IIIa inhibitors and abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
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Impact of prior statin therapy on arrhythmic events in patients with acute coronary syndromes (from the Global Registry of Acute Coronary Events [GRACE]).
Am. J. Cardiol.
PUBLISHED: 04-17-2009
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Animal models of myocardial ischemia have demonstrated reduction in arrhythmias using statins. It was hypothesized that previous statin therapy before hospitalization might be associated with reductions of in-hospital arrhythmic events in patients with acute coronary syndromes. In this multinational, prospective, observational study (the Global Registry of Acute Coronary Events [GRACE]), data from 64,679 patients hospitalized for suspected acute coronary syndromes (from 1999 to 2007) were analyzed. The primary outcome of interest was in-hospital arrhythmic events in previous statin users compared with nonusers. The 2 primary end points were atrial fibrillation and the composite end point of ventricular tachycardia, ventricular fibrillation, and/or cardiac arrest. In-hospital death was also examined. Of the 64,679 patients, 17,636 (27%) had received previous statin therapy. Those taking statins had higher crude rates of histories of angina (69% vs 46%), diabetes (34% vs 22%), heart failure (15% vs 8.4%), hypertension (74% vs 58%), atrial fibrillation (9.3% vs 7.0%), and dyslipidemia (85% vs 35%). Patients previously taking statins were less likely to have in-hospital arrhythmias. In propensity-adjusted multivariable models, previous statin use was associated with a lower risk for ventricular tachycardia, ventricular fibrillation, or cardiac arrest (odds ratio 0.81, 95% confidence interval 0.72 to 0.96, p = 0.002); atrial fibrillation (odds ratio 0.81, 95% confidence interval 0.73 to 0.89, p <0.0001); and death (odds ratio 0.82, 95% confidence interval 0.70 to 0.95, p = 0.010). In conclusion, patients previously taking statins had a lower incidence of in-hospital arrhythmic events after acute coronary syndrome than those not previously taking statins. Our study suggests another possible benefit from appropriate primary and secondary prevention therapy with statins.
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Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis.
BMC Med
PUBLISHED: 02-09-2009
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Contrast-induced nephropathy is the leading cause of in-hospital acute renal failure. This side effect of contrast agents leads to increased morbidity, mortality, and health costs. Ensuring adequate hydration prior to contrast exposure is highly effective at preventing this complication, although the optimal hydration strategy to prevent contrast-induced nephropathy still remains an unresolved issue. Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate. The objective of this study was to assess the effectiveness of normal saline versus sodium bicarbonate for prevention of contrast-induced nephropathy.
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Predictors and implications of Q-waves in ST-elevation acute coronary syndromes.
Am. J. Med.
PUBLISHED: 02-03-2009
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Q-waves in ST-elevation acute coronary syndromes carry adverse implications. We sought to determine the frequency, predictors, and implications of Q-waves in the current era that includes primary percutaneous coronary interventions.
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Current approach to the diagnosis and treatment of femoral-popliteal arterial disease. A systematic review.
Curr Cardiol Rev
PUBLISHED: 02-01-2009
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Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and surgical management of SFPA disease.
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Routine stent implantation vs. percutaneous transluminal angioplasty in femoropopliteal artery disease: a meta-analysis of randomized controlled trials.
Eur. Heart J.
PUBLISHED: 01-30-2009
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We performed a meta-analysis of randomized controlled trials comparing routine stenting (ST) with percutaneous transluminal angioplasty (PTA) for symptomatic superficial femoral-popliteal artery (SFPA) disease.
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Failure of guideline adherence for intervention in patients with severe mitral regurgitation.
J. Am. Coll. Cardiol.
PUBLISHED: 01-06-2009
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This study sought to evaluate the incidence with which adult patients with significant mitral regurgitation (MR) do not undergo surgical intervention despite guideline recommendations, and the associated considerations resulting in no intervention.
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The quality and impact of risk factor control in patients with stable claudication presenting for peripheral vascular interventions.
Circ Cardiovasc Interv
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Peripheral arterial disease is a manifestation of systemic atherosclerosis and is predictive of future cardiovascular events. Clinical trial data have demonstrated that medical therapy can attenuate cardiovascular morbidity and mortality in patients with peripheral arterial disease. The utilization and impact of recommended medical therapy in a contemporary population of patients who undergo percutaneous interventions for lifestyle-limiting peripheral arterial disease is unknown.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.